Causes of constipation in children

Once children are toilet trained, constipation can happen if they’re holding poos in.

Your child might be holding poos in because he’s too busy playing, because it hurts to do a poo, or because he doesn’t want to use the toilets at his preschool or school.

Constipation might also happen if your child isn’t drinking enough fluids or eating enough fibre, or because of an illness that has made your child eat and drink less.

These situations can all lead to a build-up of poo in the bowel. When this happens, the poo gets too hard for your child to push out easily.

There are some underlying medical conditions that might cause constipation in children, but these aren’t common.

Symptoms of constipation in children

The main symptom of constipation in children is hard poo.

A normal poo should be soft like toothpaste and easy to push out. If your child is constipated, she might feel pain and discomfort when she’s trying to do a poo or doing one. This might make her avoid going to the toilet. The hard poo might overstretch the skin around her anus and cause small, superficial tears, which might lead to pain and bleeding.

Your child might also have tummy pains that come and go. He might show ‘holding on’ behaviour such as rocking or fidgeting, crossing his legs or refusing to sit on the toilet. He might also seem generally cranky.

If your child has been constipated for a long time, she might poo in her pants without meaning to. This happens because the hard poo is stuck and stretches the rectum. Your child might then lose the urge to go the toilet because her rectum always feels stretched. Liquid poo might overflow around the old hard poo, without your child feeling it or meaning to let it go.

There’s a big range of normal when it comes to how often children do a poo. Some kids go 2-3 times a day, and other children go twice a week.

When to see your doctor about constipation in children

You should take your child to the doctor if:

you need to give your child a laxative more than a few times a year

your child’s constipation doesn’t get better after you give him a laxative, or the constipation lasts longer than two weeks

your child poos in his pants without meaning to

your child has constipation and also fever, vomiting, blood in the poo or weight loss

your child has painful cracks in the skin around his anus

your child has constipation and you’re worried he isn’t eating or drinking enough.

Treatment for constipation

Your child needs healthy bowel habits.

Diet
The first step towards healthy bowel habits is diet.

A healthy diet that has enough fibre and lots of fluids (especially water) helps to both treat and prevent constipation. Foods that are high in fibre include wholegrain breads and cereals, fruit and vegetables.

Regular toiletingIf your child is constipated, encourage her to develop the habit of sitting on the toilet regularly and pushing, two times a day for 3-5 minutes each time. Try this 20-30 minutes after meals.

It can help if your child has a footstool or box to put his feet on while he sits on the toilet. Get him to put his feet flat and lean forward slightly while pushing.

You can also teach your child to be aware of and respond to her body’s urge to poo by going to the toilet. Sometimes it can be useful to start a sticker or reward chart to praise your child for doing this.

Laxatives
You might need to give your child a laxative if he’s constipated, so he can pass the hard poo without pain.

Prune juice is a mild natural laxative that works in some children. If this doesn’t work, you should see your doctor.

Possible laxative medications include:

osmotic laxatives like lactulose, Movicol® or OsmoLax®, which increase the water in your child’s poo and soften it

liquid paraffin oil, which softens the poo

stimulants like Senekot® or Dulcolax SP® drops, which stimulate the bowel to get rid of the poo.

Some children with chronic constipation will need to keep taking laxative medications for several months. Your doctor will let you know about the appropriate course of treatment.

Constipation in babies

Your baby is constipated if her poo is dry and crumbly or like pellets, and doing a poo seems to cause her pain and discomfort. Lots of babies go red in the face and strain when doing a normal poo. This is a sign of constipation only if the poo is also hard.

It’s rare for breastfed babies to be constipated. If your breastfed baby is constipated, it’s possible he isn’t getting enough breastmilk. You might need to feed him more often.

Bottle-fed babies might be constipated because the milk formula isn’t made up correctly and doesn’t have enough water in it. Getting the formula mix right and giving your baby extra fluids might help.

Some babies can get constipated if a hard poo has caused a tear in the rectum or anus, which hurts them. They instinctively hold on, so the remaining poo gets hard and more difficult to push out.

If you think your baby is constipated, see your GP or child and family health nurse.

What’s normal?
In babies under six months, how often they do a poo depends on what they’re fed.

Breastfed babies might poo up to five times a day, or only once every five days. Their poo is soft and yellow or mustard coloured.

Formula-fed babies usually poo more often (1-2 times per day). Their poo is firmer and more green-brown.